闭合性胫腓骨下段骨折三种治疗方法的临床观察

Clinical study on three methods for the distal tibia closed fracture

目的：探讨闭合性胫腓骨下段骨折治疗方法的选择及其对预后的影响.方法：闭合性胫腓骨下端骨折62例,男39例,女23例;年龄17～63岁（平均39.6岁）.横形骨折15例,螺旋形骨折12例,粉碎性骨折35例.骨折按AO/ASIF分型：A1型12例,A2型9例,A3型6例;B1型19例,B2型16例.分别用小夹板外固定、交锁髓内钉内固定和解剖钢板内固定治疗.结果：15例小夹板固定治疗,肢体缩短在15～20 mm（平均17 mm）,骨折愈合时间平均16.5周.24例应用带锁髓内钉内固定,其中18例术后需辅助石膏托制动,2例发生切口周围的皮肤坏死,5例出现髌下疼痛;骨折愈合时间平均27.6周,其中1例出现延迟愈合.23例应用解剖钢板内固定,4例出现皮肤坏死,骨折愈合时间平均24周.结论：根据不同的骨折类型可选用超踝小夹板外固定和解剖钢板内固定治疗,但是无论何种治疗方法局部皮肤和骨膜的血运状况都是影响骨折预后的关键因素.

Objective：To study the effect of three methods for treatment of closed fracture of the distal tibia. Methods.Amony 62 patients with closed fracture of the distal tibia,39 patients were male and 23 patients were female, ranging in age from 17 to 63 years （ mean 39.6 years）. There were 15 patients with transverse fracture, 12 with spiral fracture,35 with comminuted fracture. According to AO/ASIF typing, there were 12 cases of Type A1 ,9 of Type A2 ,6 of Type A3 , 19 of Type B1 , 16 of Type B2. These patients were treated with splints, interlocking intramedullary nail and anatomic plate respectively. Results： Fifteen patients were treated with splints,the time of fracture healing was 16. 5 weeks on average,the tibial shortened from 15 to 20 mm （ means 17 mm）. Twenty-four patients were treated with interlocking intramedullary nail,among which 18 patients were fixed with the plaster slab after operation additionally,2 patients with the skin necrosis,5 with the chronic knee pain,the time of fracture healing was 27.6 weeks on average,delayed union in 1 case. Twenty-three patients were treated with anatomic plate,4 patients of all with the skin necrosis,fracture healing time was 24 weeks on average. Conclusion ： Splint or anatomic plating is chosen according to the type of fracture, but the blood of skin and periosteum is an important factor to the fracture healing.